By Ethan Fram, M.D., urology, The Portland Clinic-Downtown & Tigard
It’s normal to experience changes in sexual function and desire as you age. About half of men have some degree of erectile dysfunction by age 55, and most experience a decrease in libido over the course of their lives.
It’s also normal to feel uncomfortable talking about it. But given how common this is, I hope we can change that. While modern medicine can’t remedy all of the changes that occur with aging, many effective treatments are available to help men who are experiencing changes in their sexual health. So let’s talk.
Your general health can affect your sexual health, and vice versa
The relationship between men’s overall health and sexual health is clear. Diabetes, high blood pressure, high cholesterol, excess body weight, enlarged prostate and smoking all contribute to changes in sexual function over time. Atherosclerosis, or narrowed arteries, causes erectile dysfunction about five years before coronary artery disease shows up, signaling a warning for future heart issues.
The relationship works the other way, too: improving sexual health can improve other aspects of health. Managing low testosterone and erectile dysfunction has been shown both to reduce the risk of depression and to improve quality of life.
What’s normal vs. what’s bothersome
Instead of worrying about what changes are or aren’t normal, I encourage men to consider what is or isn’t bothersome to them. If a 50-year-old man has no desire for sex, and that doesn’t bother him or his partner, then he doesn’t have a problem. (If he has erectile dysfunction, however, he should review his heart disease risk factors.) If an 80-year-old struggles to achieve an erection and finds that bothersome, then he has a problem that could be addressed.
Improving libido and sexual function: prevention is the best cure
The keys to managing changes in libido as you age are to stay in good health, to remain socially engaged and to maintain an open dialogue with your partner. For both sexual and general health, it’s also important to stop smoking, to limit alcohol and marijuana, and to eat a healthy diet rich in fruits and vegetables. Strenuous exercise appears to be especially beneficial for men’s sexual health, and resistance training has been shown to improve testosterone levels.
Medication adjustments might help
Many medications — including those for high blood pressure, cardiovascular disease, and anxiety and other mental health disorders — can cause changes in sexual function. Your provider may be able to adjust your medications to reduce sexual side effects without sacrificing your health outcomes.
Six types of treatment for erectile dysfunction are approved in the U.S.
Viagra, Cialis and similar oral medications are typically the first line of treatment for erectile dysfunction, but they sometimes cause flushing, reflux, headaches and other side effects. Another option may be available over the counter soon: Eroxon, a topical gel, was approved in 2023 and is still awaiting release in the U.S. Injectable medications, urethral suppositories and vacuum erection devices also help many men with erectile dysfunction.
If these approaches aren’t sufficient, surgical placement of an internal prosthesis is a highly effective solution, with the understanding that it does rule out other options in the future. Specialized urologists at The Portland Clinic can perform this outpatient procedure, and can help with any of the other options, as well.
If you have a concern about your sexual health, talk to your primary care provider or a urologist who specializes in this area. Many men see improvement with lifestyle changes, and most improve with medical therapy. The best thing you can do for your sexual health is to be honest about your
condition and your goals and open to exploring the tools that are available to you.
